Reply on Recommendations for postpartum hemorrhage in women who decline blood transfusion
Bibliographic record
Abstract
Lee and colleagues call attention to an important topic 1. Increasing evidence that bleeding and allogeneic blood transfusion are associated with adverse effects on clinical and economic outcomes 2 has prompted the development of blood conservation and patient blood management strategies by leading institutions 3. Lee and colleagues refer to bloodless surgery, which is the optimal and rigorous use of appropriate hemostatic, hematopoietic, and uterotonic pharmaceuticals, devices, and blood-conserving techniques to minimize blood loss, support perfusion and oxygenation, stimulate erythropoiesis, and optimize tolerance of anemia. Additionally, in the obstetric setting, thorough patient assessment, planning, and well-rehearsed team protocols are vital, especially for women who decline blood transfusion. It is also essential for the obstetrician to be able to identify the cause of postpartum bleeding and to initiate appropriate intervention without delay according to a well-planned and rehearsed course of action. Advance discussion of a woman's wishes should include the subject of potential hysterectomy, if postpartum hemorrhage cannot be controlled rapidly. The approach to the management of these women by Lee and colleagues is generally accepted by physicians with experience in managing such cases. Regarding the use of recombinant erythropoietin, Breymann et al. reported that in a randomized trial, recombinant erythropoietin at a dose of 300 units/kg/day for four consecutive days plus iron sucrose was more effective in ameliorating postpartum anemia than intravenous iron alone 4. An article on the worldwide need for education in nonblood management in obstetrics and gynecology was published in 1994 5. In the same year, the same author presented a poster at the XIV FIGO World Congress in Montreal, Canada, summarizing various available strategies for the prevention and management of hemorrhage and anemia in obstetrics 6. The reason for my recent letter to the AOGS 7 was to highlight recent developments and the ongoing worldwide need for education, especially for emergencies in limited resource settings, where there may be increasing numbers of women who decline blood transfusions for any one of a variety of reasons, and to stimulate further discussion of this subject. Lessons learned in the care of patients who have refused blood (such as cardiac surgery, orthopedics, critical care) have benefited many other patients 3. The surgical proposal in my letter to the AOGS is founded on the well-recognized first-aid principle, “Stop the bleeding as soon as possible,” 8 and the important but not always appreciated work of AbdRabbo 9.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.044 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.003 | 0.005 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.049 | 0.040 |
| Insufficient payload (model declined to judge) | 0.014 | 0.016 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".